Mean pulmonary venous pressure (= LAP = [[2023-NOV-GM#Pulmonary capillary wedge position and pressure| Wedge Pressure]]) = 5mmHg.
BP - aagulination
pretibial myoedema
acromegaly
electrical alternans
Defaulted CKD
pulsus alternans
liver Bx consent
SBRs from old papers

- Absence of phaeochromocytoma or myocarditis.
L-dopa -> Dopamine -> Norad -> adrenaline -> ?waste products
| Phentolamine | Non selective alpha adrenergic blocker; | Used in catecholamine induced hypertension (phaeochromocytoma, tyramine ingestion in patient on MAOI |
Multiple Endocrine neoplasia syndromes
Pulmonary capillary wedge position and pressure (PCWP)
#2023GM-NOV/Q02
Pressure transduced catheter is introduced into the femoral or jugular vein.
Basic Science
Source
- Then advanced through SVC/ IVC -> right atrium -> Right ventricle -> Pulmonary artery -> Left or right branch PA.
- Position can be confirmed by the pressure tracing in each position.
- Inflation of the balloon blocks off the branch PA -> after a few seconds, pressure distal to the balloon approximates left atrial pressure.
- Ideally, the catheter tip should be in an arterial segment supplying a "[[2018-OCT-BSQ#Pulmonary vascular resistance|Zone 3]]" region of the lung. (Alveolar pressure is less than PA and PV pressure so that blood stream from PA to PV is uninterrupted -> pressure is transmitted from LA to catheter port)
Clinical context
- Clinical Use:
- Diagnosis of severity of left ventricular failure
- quantify degree of mitral valve stenosis
- AS, AR, MR also ⬆ LA Pressure
- Measurement of cardiac output by thermodilution.
- Calculation of pulmonary vascular resistance (based on measurement of pulmonary blood flow, pulmonary artery pressure and PCWP)
- Values: Pulmonary oedema likely above PCWP > 20mmHg.
- Complications: Pulmonary artery rupture from over inflation of the balloon.
- Pitfalls: Proper placement is essential for accurate results:
- Placement is confirmed by Source
- Presence of well defined a and v waves.
- Fluoroscopic confirmation of position
- Oxygen saturation > 90%
- In the proper wedge position with complete occlusion, saturation should approximate left atrial saturation (i.e > 90%). Lower saturation indicates incomplete occlusion by the balloon. Source
- Abrupt rise in mean pressure when the balloon is deflated.
Phaeochromocytoma
Basic Science
- Tumour of adrenal medulla which secretes catecholamines (Adrenaline and noradrenaline).
- 
- Extradrenal tumours (paragangliomas) produce mainly noradrenaline. Others produce both.
Clinical context
- A Very rare cause of hypertension
- Associations: [[2022-November#Multiple Endocrine neoplasia syndromes|MEN2]], VHL and neurofibromatosis.